Transfer of sick children by air.

The annual growth rate of air traffic is increasing at the rate of about 7% all over the world. Children and adolescents make a significant chunk of travelling population. Some of the neonates too take to civil air and travel under various circumstances. Others travel for the reasons of medical air evacuation and better treatment at some specialized tertiary care centers, within India or abroad or simply as medical emergency. With the increasing availability of air taxis and air ambulances, it has become necessary for the pediatricians to know the consequences and potential hazards of transfer of the sick by air, lest they lose their patients unintentionally despite professional proficiency. Air evacuation of sick child is a highly specialized job, much different from an evacuation by any fast car ambulance. The paper discusses the general impact of aviation stresses in civil aviation with special reference to sick neonates, children and adolescents, and provides general guidelines, which could be applied to any particular clinical condition with knowledge of underlying physiological processes and anticipated alterations in cabin environment. It also brings out the issues of proper pre-flight assessment, fitness to undertake air transfer, general handling of patient under transfer, desirable onboard procedures, do s and don ts during air transfer, limitations of conventional neonatal/child resuscitation kits, available medical support in aircraft cabins, proper use of hardware including physiology monitoring systems, permissible specialized medical aids, and the requirement and use of equipment during air evacuation. The importance of high awareness and preventive measures is reiterated.